ANALYSIS:IF MANY of the disturbing findings in the reports into the deaths of children in care over the past 18 months sound familiar, that's because they are.
Similar recommendations can be found in the reports of other cases such as the Roscommon abuse case, Kilkenny incest case, Kelly Fitzgerald case in Mayo, as well as reviews into the deaths of troubled teens in care such as Tracey Fay and David Foley.
Yet most of the recommended changes – better co-operation and communication between State agencies, a standardised approach to dealing with abuse concerns, more emphasis on preventive measures and full implementation of child protection guidelines – have been marked by the same pattern of inaction.
What is encouraging this time around is that these reports and recommendations are being published proactively by the recently established National Review Panel for Serious Incidents and Child Deaths.
The degree of transparency of the group – independently chaired by Dr Helen Buckley of Trinity College Dublin – is a positive development in the ongoing struggle to learn lessons and improve the standard of care provided to all vulnerable young people.
Despite the shocking headline figure of 35 deaths over the past 18 months, there are tentative signs of progress. None of the deaths during 2010 were directly attributable to a failure by the Health Service Executive. The relatively few infant deaths, when natural causes are extracted, is an encouraging sign that our system of public health nurses and preventive work on the ground may be working. In the United Kingdom, for example, children under the age of five account for almost 60 per cent of deaths in the care system.
But what is disturbing is how the same failures in the same child protection system are continuing to affect young people at risk.
Incredibly, the executive still does not have a standard method for assessing the needs of vulnerable children. This means that a child can get a different response, depending on where they live or on pressures on the local social work system.
The pressure on frontline social work services also means that overworked social workers are unable to respond to thousands of cases of suspected abuse or neglect. In one case, the death of a four-month-old baby in July 2010, there was a time lapse of almost two years between when the Garda notified the HSE of child protection concerns and when the executive finally met the family face-to-face.
The absence of inter-agency co-operation and communication once again emerges as a major issue. The fact that key services within the HSE are not sharing information or working together is the sign of a dysfunctional service in urgent need of reform.
What emerges from the reports is a system where, in many cases, social workers are doing their utmost to prevent young people slipping through the cracks, despite problems in the system.
Yesterday, the HSE pledged to act on all the recommendations and said many of these steps are already under way. These include updating professional practice guidance and procedures.
In addition, the Government has prioritised reforms to the child protection system and has pledged to establish a new child protection agency.
But actions speak louder than words. Health authorities will ultimately be judged by whether they implement recommendations or whether they will be repeated once again in yet another series of critical findings.
Case studies: Five stories of death and disability
BABY G
A report into the death of four-month-old “Baby G” criticised an “unacceptable” delay of almost two years it took for social services to respond to concerns over her teenage mother.
The mother – Ms J – and her family had been known to social services as early as 1998 due to alleged neglect and drug abuse in the wider family. In 2006, a garda expressed concern to social services over domestic violence in the home. While the case was opened, it took 22 months before Ms J had a meeting with social workers, shortly after she became pregnant. Ms J was described as vulnerable and prone to depression. The child was born in 2010 and died from “sudden unexpected death”, with no signs of abuse or neglect.
While there was no direct connection between any inaction on the part of the HSE and Baby G’s death, the report found that the level of service provided to Ms J was “negatively affected by systemic issues”. These included a 22-month delay between social services being alerted to Ms J’s needs and her first face-to-face contact with social workers.
In addition, there was no standard method to assess her needs and no pre-birth assessment to ascertain her capacity to care for the child. No case conferences or interagency meetings took place at any time, which might have enabled the family to address domestic violence issues. A lack of services for under-18s – such as mental health services, accommodation for young and vulnerable mothers – also meant some of Ms J and Baby G’s needs were not met.
MR Q
Q had been in care between the ages of six and 18 years of age. He was found dead following an accident while sleeping rough.
It says he suffered a very chaotic and traumatic early childhood, including parental abuse and neglect.
He witnessed a number of traumas in childhood and began to misuse alcohol and drugs. He dropped out of education and drifted into criminal behaviour.
The review concluded there was no direct link between his death and inaction by the HSE social services. It says there is ample evidence that social workers responded to requests for help for him. The failure to have on-going assessment was a management shortcoming.
BABY M
Five-month-old Baby M died as a result of a congenital development disorder and was cared for by his mother and father. His mother had been known to child protection services due to drug use and and had older children in foster care.
The review found there was no evidence of any parenting concerns in relation to Baby M. The practice of the HSE social worker who managed the case was generally of a high standard.
CHILD C
Child C died three months before his 18th birthday as a result of complications associated with diabetes. The child was known to the child protection services six months before his death. But the review did not identify any inaction by the HSE which was a contributory factor to his death.
The report found, however, there were “communication” gaps which had implications for his wellbeing and a two-month delay in assessing his needs by over-worked child protection staff.
While he had a serious medical condition, interviews with his GP and hospital consultant later revealed his attendance for appointments was erratic. The report says the HSE should introduce a screening tool to highlight chronic illness in a child.
Child W
A 14-year-old boy suffered a potentially life-threatening fall through the roof of a building near his home in October 2010. The report says the HSE responded pro-actively to a potential concern over possible neglect. The boy has since made a good recovery and he and his mother are receiving support from the HSE.
Child L
The report says Child L – who was 18 years of age – was involved in a “serious incident” which left him with significant disabilities. The teenager had been in the care of HSE from when he was a small child up until his 18th birthday. The report found his care placement was stable and well supported. The only issues raised were gaps in guidelines, such as sub-standard case notes.